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目的:探讨年龄校正的D-二聚体(D-dimer)结合临床风险评估在老年人急性肺栓塞(PTE)的诊断中的临床应用价值。方法:对疑患PTE的老年患者(≥60岁)进行修正的Geneva评分,根据评分结果分为低风险组及高风险组;D-二聚体分别使用传统临界值(500 ug/L)及年龄校正临界值[(年龄×10)ug/L]对诊断PTE的特异性及敏感性进行比较。结果:在356例患者中,191例为低风险组,165例为高风险组。在诊断PTE的特异性上,D-二聚体年龄校正临界值显著优于传统临界值(低风险组:41.0%vs 23.4%,高风险组:76.3%vs 55.9%,P<0.05),而在诊断PTE的敏感性上,两组无明显差异(P>0.05)。结论:年龄校正的D-二聚体临界值结合修正的Geneva评分可提高老年患者诊断PTE的特异性。
Objective: To investigate the clinical value of age-adjusted D-dimer combined with clinical risk assessment in the diagnosis of acute pulmonary embolism (PTE) in the elderly. Methods: The Geneva scores of elderly patients (≥60 years old) with suspected PTE were revised and divided into low-risk group and high-risk group according to the scoring results. D-dimer used the traditional threshold (500 ug / L) and The age-adjusted cutoff [(age × 10) ug / L] compared the specificity and sensitivity of the diagnostic PTE. Results: Of the 356 patients, 191 were low-risk and 165 were high-risk. Age-adjusted cut-off values for D-dimer were significantly better than the traditional cutoff values for diagnosis of PTE specificity (low risk group: 41.0% vs 23.4%, high risk group: 76.3% vs 55.9%, P <0.05), whereas In the diagnosis of PTE sensitivity, no significant difference between the two groups (P> 0.05). CONCLUSIONS: Age-adjusted D-dimer thresholds combined with a modified Geneva score improve the specificity of diagnosis of PTE in elderly patients.